OCD or Anxiety? John Green And A Clinical Expert Explain

Summary

Podcast Summary: Get to Know OCD — "OCD or Anxiety? John Green And A Clinical Expert Explain"

Host: Dr. Patrick McGrath (Chief Clinical Officer, NOCD)
Guests: John Hibben (Person with OCD), OCD Therapist (Clinical Expert)
Date: February 9, 2026

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Overview

This episode tackles one of the most common sources of confusion in mental health: the overlap and key differences between Obsessive-Compulsive Disorder (OCD) and generalized anxiety. John Green (author and OCD advocate, here pseudonymized as "Person with OCD"), John Hibben (host), and a clinical OCD expert walk listeners through hallmark symptoms, real-life experiences, and practical treatment guidance. The conversation is candid, relatable, and filled with hope for those struggling with OCD.

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Key Discussion Points & Insights

1. OCD vs. Anxiety: Hallmark Behaviors and Misunderstandings

• Misdiagnosis is Common
  • John Green reflects on being treated for anxiety before his OCD diagnosis.

    "I was treated for and assumed to have generalized anxiety before I was eventually diagnosed with OCD."
    (00:02, Person with OCD)

• Symptom Overlap
  • Many OCD symptoms—such as reassurance-seeking, overthinking, confessing thoughts—are mistaken for regular anxiety.

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2. Deep Dive into Core OCD Symptoms

a. Reassurance Seeking

• Amplified by OCD:
  • Unlike typical anxiety, OCD’s reassurance seeking is relentless and insatiable.
  • OCD Therapist:

    “OCD is that on steroids… the more checking you do in OCD, the less confidence you have.”
    (00:25, OCD Therapist)

• Cyclical Nature:
  • John Green describes the repetitive, never-satisfied urge:

    “You often come back over and over and over again needing reassurance.”
    (01:09, Person with OCD)

b. Mentally Arguing or Debating with Yourself

• Endless Inner Debates:
  • Sufferers rehash conversations to ensure nothing was left unresolved or offensive.
  • OCD Therapist:

    “It's almost like you've got debate teams going back and forth within your head.”
    (01:43, OCD Therapist)

• Persistence from Childhood:
  • John shares how this has been a lifelong pattern, though now better managed.
    (02:26, Person with OCD)

c. Need to Confess Past Actions or Thoughts

• "Leaky Bucket" Analogy
  • No amount of reassurance or confession ever feels like enough.
  • OCD Therapist:

    “…there's a hole in the bucket, and therefore, all of the ‘okays’ and ‘you're fines’ keep falling out.”
    (02:52, OCD Therapist)

• Seeking Validation from Anyone:
  • Even strangers might get drawn into the confessional loop.

d. Overthinking (the “Yeah, but what if?” Disease)

• No Finish Line:
  • The process is likened to Sisyphus eternally pushing a boulder—never reaching certainty.
  • OCD Therapist:

    “If you think of OCD as being this driver... but there's not actually a finish line to attain it...”
    (03:53, OCD Therapist)

• Compulsive Spiral:
  • John calls it “the yeah, but what if? disease,” describing endless hypothetical concerns.
    (04:42, Person with OCD)

e. Mentally Rehearsing for the Future

• Attempting to Control Unpredictable Life Events:
  • OCD pushes sufferers to rehearse all possible outcomes, exhausting and impossible.
  • OCD Therapist:

    “Have you ever figured out every situation you'll be in for the rest of your life?”
    (05:40, OCD Therapist)

f. When Does Anxiety Become OCD?

• Duration and Impact are Key:
  • “When it gets to a point…an hour or more of your day is taken up on this…up to eight hours…”
  • The distinction lies in the time and energy spent, and the level of impairment.
    (06:24–07:27, OCD Therapist)

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3. Getting the Right Treatment

• Talk Therapy vs. Evidence-Based Treatment
  • Standard “talk therapy” can reinforce compulsions if it offers immediate reassurance.
  • Best practice is Exposure and Response Prevention (ERP) therapy, targeting the compulsions directly.
  • OCD Therapist:

    “If you're teaching people [to replace a feared thought instantly], that becomes an instant compulsion...”
    (07:38, OCD Therapist)

• Living with Uncertainty
  • The goal is not to erase discomfort, but to live with it:

    “I don't even like to say sit in it anymore, I say live with it... The difference...is those without OCD go, 'okay, maybe,' and those with OCD get caught in that spiral…”
    (07:38–08:44, OCD Therapist)

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Notable Quotes & Memorable Moments

• The Hopeful Message:

  • John Green’s closing remarks emphasize hope and persistence:

    "Even when your brain tells you there isn't, hope is the correct response to consciousness. It takes a lot of bravery to turn that hope into action…But help is available, and it can be transformational...It's worth it. It really is worth it."
    (09:05–10:40, Person with OCD)

• Letting Go of Control

  • OCD Therapist:

    “It's okay to be uncomfortable even though OCD says it’s not.”
    (08:44, OCD Therapist)

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Key Timestamps

• 00:02: The confusion between OCD and generalized anxiety
• 00:25–01:38: Reassurance seeking and "checking" compulsions
• 01:43–02:26: Mentally arguing/debating with oneself
• 02:43–03:37: Compulsive confessions
• 03:49–05:19: Overthinking and the “yeah, but what if?” spiral
• 05:30–07:27: Mentally rehearsing and distinguishing normal anxiety from OCD
• 07:34–08:44: Why ordinary talk therapy can be harmful for OCD
• 09:05–10:40: Personal transformation through ERP and message of hope

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Closing Thoughts

• OCD and anxiety are easily confused, but understanding the distinguishing patterns—and knowing when symptoms become disruptive and compulsive—is key to receiving the proper help.
• The lived experiences shared, paired with clinical insight, empower listeners to recognize OCD in themselves or loved ones, and seek effective, evidence-based treatment.
• There is hope, and treatment (ERP) is effective and transformative. NOCD and similar organizations are ready to help.

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For more resources or support, visit nocd.com.

Transcript

[John Hibben]

So OCD is one of the most.

[Person with OCD]

Misunderstood mental health conditions out there. And I know that I was treated for and assumed to have generalized anxiety before I was eventually diagnosed with ocd. And so today we're gonna go through.

[John Hibben]

Some of the hallmark symptoms of OCD that are often seen as symptoms of anxiety. Wonderful.

[OCD Therapist]

Let's do it.

[Person with OCD]

So the first one is asking for reassurance.

[OCD Therapist]

Boy, who doesn't ask for reassurance? It's a common everyday experience for anybody who would like to get someone else's opinion to know for sure. OCD is that on steroids, though. So you see this as a hallmark of almost all anxiety conditions. People who panic will run to the emergency room because they want reassurance they're not dying of a heart attack. Right. People with generalized anxiety disorder will want reassurance that the thing they're worrying about is going to turn out okay. People with OCD will want that reassurance to know that this. This huge thing that could occur, all because I had this one little thought, image or urge won't blow up the world or something like that. So reassurance, definitely an experience that you'll see, but it is on steroids for ocd.

[Person with OCD]

And in my own experience, I mean, I've lived with quite a lot of needing reassurance with ocd. And in my own experience, you often, like, come back over and over and over and over again needing reassurance.

[OCD Therapist]

Yes. Once you get it, it's not enough, so you're going to try for it again. And in fact, we know from research that the more checking that you do in ocd, which can be one form of reassurance, the less confidence you actually have in something. So as you do it more, you actually get less from it.

[Person with OCD]

That has certainly been my experience. Next one, mentally arguing with yourself.

[OCD Therapist]

Oh, yeah, how do I know that? I've gotten all the points across. So I need to have almost this internal debate to make sure that I've covered absolutely everything. And it's almost like you've got debate teams going back and forth within your head to try to assure yourself that everything was done correctly, you didn't offend someone. You know, just a myriad of things that you might be worried could occur. And I've even seen people sometimes after a session, sitting out in a waiting room for hours after the session. And if I go up to them and say, what's going on? They've said, well, I was just thinking, had I said this to you, then you might have said this, then I could have Said that, and then you would have done that. And I'm wondering if those types of things happen to you too, with interactions.

[Person with OCD]

Yes, very much so. And ever since I was a kid, and it's a huge part of my life and something that I'm constantly having to deal with, I've gotten a lot better at dealing with it over the last. I would say 10 or 15 years. But, yeah, it's definitely part of my life. Okay, I have another one for you.

[OCD Therapist]

What do you got?

[John Hibben]

Needing to confess past actions or thoughts.

[OCD Therapist]

Can you ever be forgiven enough, John? Would be the question.

[Person with OCD]

No, no, no, not me.

[OCD Therapist]

Yeah, no, no. And so it's almost like the leaky bucket aspect. I'd like you to fill my bucket with enough, telling me I'm okay and everything's fine, but there's a hole in the bucket, and therefore all of the okays and your fines keep falling out. So you keep needing more and more, and it doesn't matter how many people, and they don't even have to know you. Right. You might be in the line at the grocery store, and you might just strike up a conversation. By the way, has anyone ever talked about this with you? And what would you say about a person like that? And if they say, oh, I wouldn't like them in your head, you're like, oh, shit. Oh, damn. There it is. There it is.

[Person with OCD]

I knew it.

[OCD Therapist]

Yeah. And now I'm gonna need some more okays in order to be fine.

[Person with OCD]

Right, right. So that's a classic OCD symptom, but one that's often mistaken for anxiety.

[OCD Therapist]

Yeah. Or just maybe we say you're just an overthinker, but it could actually be.

[John Hibben]

A compulsion, which is the perfect segue to my next one, overthinking.

[OCD Therapist]

Oh, you've never overthought anything, John Hibben.

[Person with OCD]

I've never underthought anything.

[OCD Therapist]

Maybe that's a better statement, right? If that's the case, yeah. Can you ever think enough about something? I mean, if you think of OCD as being this driver that says there is something to attain, but there's not actually a finish line to attain it, then how could you ever think enough about something? So this idea that you can actually achieve this nirvana thought is a joke to ocd, where it says, that would be lovely to attain. Good luck in getting. I think of the Greek myth of Sisyphus, Right. Where Sisyphus is for eternity. Rolling this hill up, or rolling the stone up the top of this hill, and it's £1 too heavy. And that hill is 1 degree too steep to actually attain it, and therefore he's driven to become a demigod. But he's never going to get there.

[John Hibben]

Yeah.

[Person with OCD]

I mean, I think about it in the context of my own OCD as a com. It really is a compulsive behavior, this overthinking, and it's. You've called it the yeah, but what if? Disease. And for me, it's that overthinking around. Yeah, but what if? Yeah, but what if? Yeah, but what if? And I can stay in that spiral for literally forever.

[OCD Therapist]

It doesn't matter how many rational, logical, whatever answers I give you, you will always have another, yeah, but what if? So that means my logic as an OCD therapist and your logic as a person with OCD are on different planes.

[Person with OCD]

Right, Right.

[OCD Therapist]

And so I could fall into the trap as a therapist of trying to give you solutions, or I could really do what needs to be done, which is help you to live with the doubt and the uncertainty.

[Person with OCD]

Another thing that commonly is seen as anxiety is like mentally rehearsing yourself for things that are gonna happen in the future or for situations that you're gonna be in.

[OCD Therapist]

Yes. Have you ever figured out every situation you'll be in for the rest of your life?

[Person with OCD]

Not yet.

[OCD Therapist]

How much have you tried?

[Person with OCD]

I'm gonna keep at it.

[OCD Therapist]

Exactly Right. And that's the problem, that there's just no way to know any or all of the situations that you're going to face at some point in the future. Right. I could leave this interview and fall down the stairs and break my leg, and that's gonna change the trajectory of things for the next several months of my life, if that's the case. So how much time should I put into thinking about that? Or can I just accept the fact that I don't know what's going to happen and I'm going to live with the reality of the fact that I can't know exactly what's going to happen.

[Person with OCD]

So when do I know if that's anxiety or that's ocd?

[OCD Therapist]

I would really take a look at how much time and energy is being spent in that. Right. I mean, who doesn't have a little bit of anxiety about certain things in the future? I want to normalize that, that there are people who, if you've got a graduation coming up or it's now college decision time, there's nothing wrong with having some anxiety around those things. But when it gets to a point, and it's even written in the diagnostic manual, that it's an hour more of your day is being taken up on this. And you've described sometimes up to eight hours of your day being taken up with these things that when it hits that level and it's really causing interference in your life and your ability to do the things that you love or enjoy, to work, to write, to interact with your family, to be able to even leave your room sometimes because you're just like, just one more minute, that's all I need. And you've probably said that to people, I just need just one more minute. And that's really another couple of hours of your life. And that's when I really look at. Here's where it turns into OCD is this level of interference is so impairing in your life.

[Person with OCD]

And that's exactly why I just think it's so important to be able to seek treatment.

[John Hibben]

And the right treatment for ocd, that.

[Person with OCD]

Treatment, that sort of standard talk therapy.

[John Hibben]

Can actually be harmful.

[OCD Therapist]

Yes, it can be. If it's providing people those immediate, gratifying safety behaviors. Right. So if you're teaching people that every time you have a thought you don't like, I want you to replace it with one you do, well, that becomes an instant compulsion for somebody with obsessive compulsive disorder. Right. And so what we want to make sure that we're doing is always working on getting people to live in the doubt, live in the uncertainty. I don't even like to say sit in it anymore. I say live with it. Right. Because we all actually do live with it. The difference, I think, between people who do or don't have OCD is those without OCD go, okay, well, maybe. And those with OCD get caught in that spiral that you like to talk about, right? That it's hooked in. There's so much emotion in that that it just catches and it's hard to release. Right. This is bad fishing. Right. This is not catch and release fish. This is catch and struggle and struggle and struggle and struggle kind of fishing. And we want to really help people learn how to release that and just let that thing be there. It's okay to be uncomfortable even though OCD says it's not.

[Person with OCD]

So if you think that maybe it.

[John Hibben]

Is an anxiety and maybe you do have ocd, the good news is that this is a treatable condition and OCD is here to help.

[OCD Therapist]

Absolutely. That's what we do at nocd. We work on pairing you with a trained therapist who knows what the evidence based treatment for OCD is. That's exposure and response prevention Therapy.

[John Hibben]

So before treatment, I would often have an elevated heart rate. I could barely be on the Internet without feeling, like, a constant sense of panic. I would feel overwhelmed all the time. I would be consumed by dread. I would feel guilt and shame and fear and anxiety. And after treatment, my life is very, very different now. That's not to say I don't have OCD anymore or that those OCD symptoms won't come back. Of course I do, and they will. But my life isn't controlled by OCD the way that it used to be. So for me, confronting my OCD has absolutely been worth it. And if there's one message I would share, it's that there is hope. Even when your brain tells you there isn't, hope is the correct response to consciousness. And it takes a lot of bravery to. To turn that hope into action, to turn that hope into the action of getting help. But help is available, and it can be transformational. So if you're hesitant to face your fears, which God knows I was, please hear this. It's worth it. It really is worth it. And in my own life, it can be hard to apply the lessons I've learned sometimes. Like, I don't want to be uncomfortable. And in the moment, doing exposure and response prevention therapy can make me feel uncomfortable. And response prevention can make me feel uncomfortable. But again, I believe that it's worth it. And if I can remind myself of that, that on the other side of this discomfort lies a greater ability to live in the world, then I can do it. I know facing OCD can feel overwhelming, but you don't have to do it alone. That's why NOCD is here.

[Person with OCD]

They're here to help.

[John Hibben]

You can visit nocd.com to schedule a free call with their team and get matched with a NOCD trained therapist. They have licensed therap who are trained at treating OCD with exposure and response prevention therapy. They'll create a plan tailored to your specific needs and guide you every step of the way. Making the call to start treatment was a difficult moment in my life, born of true desperation. But gosh is current me grateful to past me for making that call.